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Pushing the boundaries of youth HIV prevention: Looking bac &k Moving forward 25-27 November 2009 CONFERENCE SUMMARY REPORT &%nZVgh Introduction A loveLife promotes healthy, HIV-free living among South African teenagers. Organised under the auspices of the New loveLife Trust, loveLife combines a sustained high- powered multi-media campaign with nationwide community-level outreach and support B programmes for youth. loveLife’s programmes are implemented by a national youth volunteer service corps known as groundBREAKERS and mpintshis in partnership with more than 200 community-based non-government organisations, 5600 schools and 470 government clinics across South Africa. Major funding for loveLife is provided by the South African Government and the Henry J. Kaiser Family Foundation. Additional support is provided by Avis, Barloworld, BMW, DED (German Development Service), Dewey & C Le Boeuf, Independent Newspapers, Jumpstart, Mondi Shanduka, Murray & Roberts, Rapport, Royal Bafokeng Holdings, the South African Broadcasting Corporation, Ster- Kinekor, Tone Digital and the Vodacom Foundation. For more information visit www.lovelife.org.za or call 0800 121 900. D E F G H Glossary 2 Contents Introduction A B Introduction: A frank reflection: loveLife ten years later (1999 – 2009) 4 A: Mapping out the context 13 C B. Youth leadership for HIV prevention 28 C. Engaging communities 39 D D. Strengthening institutional response to HIV and Aids 44 E. The new frontiers 70 E F. Building on existing successes 88 G. Co-operation models 89 F H. Group discussions, report backs and action plans 92 Glossary of acronyms 101 G H Glossary 3 Introduction Introduction A frank reflection: A loveLife ten years later (1999 – 2009) B PRESENTER: Dr David Harrison Programme Director: Connected! The last ten years of loveLife’s existence have been challenging as well as rewarding. We couldn’t have chosen a better time to initiate such a major national HIV/Aids programme in Africa and most certainly Southern Africa. 1999 was the year in which C South Africa in particular was experiencing a spike in the mortality phase. While people were dying, the Mbeki administration was reluctant to address the HIV/Aids issue head on. loveLife, however, grabbed the bull by the horns. Against all odds, we are here to share our story – ten years later. Let’s take an evolutionary journey of our strategy and approach to the campaign, including our controversial visual billboard creatives. D 1. HOW IT ALL BEGAN THE STATISTICAL EVIDENCE E Back in 1999, all we had to work with in South Africa was the national ante-natal public clinic surveys. What we saw was that the epidemic prevalence had jumped from 0.7% in 1990 to 22.8% by 1998 in young women (Department of Health, ante- natal surveys). When we broke down this information it became clear that about 55 to 60% of the infections were happening before young women reached the age of 25. The fact that it was happening in a society made up of 40% of young people under the age of 20, created an opportunity for loveLife: we believed that if we could stop the next generation of young people from becoming infected, we could reverse the cause of the epidemic; we had an idea at that stage of what was high-risk F behaviour was; we were able to model the risk profile in South Africa, including both high and low risk. The results were straightforward: the majority distribution in the high-risk pool was skewed towards young people. We needed to do something to move these young people out of the high-risk pool – even just a 20% shift could trigger a drop in the infection rate of HIV. OUR FOCUS G From the numbers we were exposed to, it was clear that HIV was widespread among young people. Because of the youth bubble, the skewed distribution could create a disproportionate effect over a relatively short period of time. Focusing on young people was critical if we were going to crack the epidemic. UNDERSTANDING THE YOUTH H Getting to young people was a challenge. The first thing we had to do was move beyond academia and really understand young people. Plainly, we needed to understand the following: • What made them tick? • Where they were coming from? • What the influences were in their lives? • What could potentially change them? Glossary 4 KEY INSIGHTS Introduction Between 1994 and 1999, post the democratic elections, the percentage of households that had electricity increased from 45% to 76%; with electricity came greater access to TV. In addition to radio, TV became a huge part of young people’s lives. TV brought with it a sense of global proximity, with popular culture splashed in the media. Young people began to experience sudden and fantastic A influences that led them to wanting to be part of this global world, yet, at the same time, the world was opening up conflicting concerns for young South Africans. Through surveys we found that young people were concerned about AIDS, TEENAGE PREGNANCY, CRIME, and SEXUAL ABUSE AND VIOLENCE. Their priorities were getting an education, protecting themselves and loved ones from B HIV/Aids, marrying and having a stable family life and finding employment. The youngsters of that time had dreams, priorities and challenges that were very much influenced by the glitz and glamour of the globalising world, informed by electronic media, radio and TV. In creating a campaign and a programme for young people, these were the dilemmas to which loveLife had to respond. In late 1999, a provocative billboard appeared – simply called FOURPLAY. It remained mounted for three months, across the country. C THE FIRST BILLBOARD: THE BIRTH OF loveLife – DIPSTICK The FOURPLAY billboard carried a message that triggered dialogue. People started asking what was going on and why the message was sexually explicit. At the time, discussions of sex and sexuality were far more constrained and much less discussed than today. The billboard therefore caused quite a stir in 1999. This was a precursor to the programme that loveLife has become today. D CHALLENGE NO. 1: When we started, our insight was an understanding of young people on the one hand, and recognition that the linkages between sex and HIV had not been made. At best, the ‘Red Ribbon Campaign’ had made the connection between the red ribbon and HIV, but very little connection between HIV and sex. E CHALLENGE NO. 2: Getting people to talk about HIV and sex, not solely about sex. It was also about talking about loving, values and ultimately about life. It wasn’t difficult for the pieces to fall in place from there, and come up with the ‘Talk about it’ logo and the power of an aspirational brand for young South Africans. OUR GOAL F Our aspirational goal was to halve HIV/Aids among young people between the ages of 15 and 24, within five years. This was written off as too ambitious, and that we were suggesting we would do it all alone. The epidemic was so big that we had to set ambitious goals otherwise we would not have been able to mobilise the resources to create the impact we wanted. We realised we had to go big and bold. Our plan was to do this by increasing partnerships to make a massive dent in this epidemic, no apologies made. G 2. FIRST PHASE OF THE CAMPAIGN The first part of the campaign was to create a climate that would open the discussion, where people were willing to talk. H Looking back at these billboards, it is amazing what people were NOT talking about at that stage. The first set of billboards was really just about trying to inculcate a sense of talking/dialogue. FIRST SERIES OF BILLBOARDS (LATE 1999) • What’s your position? • Get your point across • Use your mouth Glossary 5 After the first series of billboards people still didn’t get what loveLife was about. Remember, this Introduction was still an attempt to create the need to talk about sex, as these messages had a slight sexual nuance. While people were trying to comprehend what loveLife was about, we hit them hard with the next series of billboards. A SECOND SERIES OF BILLBOARDS We personified the messages. We used the actual words young people were using around the country. This is what they were telling us: B “I had sex, will I die?” Siphiwe, 14 “My boyfriend is cheating on me – am I going to get the disease?” Bettie, 12 “What if the condom came off when he’s inside of me,” Nomsa, 13 C We put the questions that young people were asking into the public sphere. People were horrified. As a result, loveLife had to spend a huge amount of time before the Advertising Standards Authority and the Broadcast Complaints Commission. OUR RESPONSE: We presented what young people were saying to us, and the questions they were asking. loveLife believed that if we were not prepared to confront and answer them, we were not going far enough in our attempt to combat the D epidemic. Having made the connection between the need to talk and young people’s sexual behaviour, we could then bring ‘Talk about it’ and ‘sex’ into the context of HIV. We then addressed the questions which were being asked by the Advertising Standards Authority and the Broadcast Complaints Commission: ‘Why talk about it? Why is it about sex?’ E The billboard simply read: The Future Ain’t What It Used To Be ...+HIV? Although approximately 85 to 90% of the billboards were very effective in stimulating the discussion, the following did not work: F A billboard of a pregnant teenager – BEFORE ACCIDENTS HAPPEN ...TALK WITH YOUR CHILDREN ABOUT SEX and THE FUTURE AIN’T WHAT IT USED TO BE..